# Importance of Vaccination Against COVID-19 in a Patient With End-Stage Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

## TL;DR

A fully vaccinated patient with severe rheumatoid arthritis and lung disease survived a severe case of COVID-19.

## Contribution

Highlights the protective role of vaccination in a high-risk RA-ILD patient during severe COVID-19.

## Key findings

- The patient survived acute respiratory failure possibly due to full vaccination.
- Vaccination may offer additional protection in high-risk RA-ILD patients.
- Case suggests vaccination can improve outcomes in RA patients with ILD.

## Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammatory polyarthritis and extra-articular involvement. Extraarticular manifestations of RA can include involvement of the skin, eye, heart, lungs, and others. RA is associated with a broad spectrum of pleuropulmonary involvement, with interstitial lung disease (ILD) and pleural disease being the most common. COVID-19 infection cross-talks with RA at various stages of pathogenesis. The clinical course and outcome of COVID-19 infection in RA patients may be ameliorated due to various reasons including anti-rheumatic drugs; however, COVID-19 vaccination provides additional protection to high-risk patients compared to non-vaccinated patients. Here, we present a case of end-stage RA-associated ILD who presented with the chief complaint of shortness of breath and tested positive for COVID-19. She was a lung transplant candidate on long-term antifibrotic medication nintedanib for interstitial fibrosis. The patient survived the initial acute hypoxemic respiratory failure, which might be attributed to being fully vaccinated for COVID-19.